3mth Upfront ALTONA App

In Balance Fitness -3 Month

Paid upfront Membership
I am under 16 years old:*

YesNo
If you are under 16 years old, please read and acknowledge each of these conditions:*

If under 16 you must have a Parent/Guardian present with you outside of staffed hours, additionally you must have a gym induction prior to your membership commencing
Consultant*
Full name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState

Post Code
Birth Date*

DayMonthYear
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Emergency Contact*

First NameLast Name
Emergency Contact Phone Number*
Please enter a valid phone number.
Important information when choosing your Membership Term: By opting for a longer membership term, you enjoy the benefits of significantly reduced rates, reflecting our commitment to rewarding your dedication to long-term fitness goals. Please be aware that selecting a specific term entails a commitment for the entire duration at the agreed-upon discounted rate. Cancelling membership during the term will incur liability for the remaining balance.

CANCELLATION

Please note there are no refunds on UPFRONT memberships, however you can transfer your membership to a friend, family member, but must be a non-existing current member.
SUSPENSION

please read and check each of the following condition.
I acknowledge that I can suspend the membership's payments for a fee of $2.00 per week. Also, medical suspension, supported by a doctor's certificate outlining dates and reasons, is offered free of charge.*

I have read and understand this condition
I also acknowledge that the membership freeze or hold does not reduce the total term of the membership.*

I have read and understand this condition

	Yes	No
Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor?
Do you feel pain in your chest when you do physical activity?
In the past month, have you had chest pain when you were not doing physical activity?
Do you lose balance because of dizziness or do you ever lose consciousness?
Do you have bone or joint problem (for example, back, knee, or hip) that could be worsen by a change in your physical activity?
Is your doctor currently prescribing drugs (for example water pills) for your blood pressure or heart condition?
Do you know of any other reason why you should not do physical activity?

In Balance Fitness -3 Month